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Smoking and Multiple Sclerosis: An Updated Meta-Analysis

Handel, AE; Williamson, AJ; Disanto, G; Dobson, R; Giovannoni, G; Ramagopalan, SV; (2011) Smoking and Multiple Sclerosis: An Updated Meta-Analysis. PLOS ONE , 6 (1) , Article e16149. 10.1371/journal.pone.0016149. Green open access

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Abstract

Background: Multiple sclerosis (MS) is a leading cause of disability in young adults. Susceptibility to MS is determined by environmental exposure on the background of genetic risk factors. A previous meta-analysis suggested that smoking was an important risk factor for MS but many other studies have been published since then.Methods/Principal Findings: We performed a Medline search to identify articles published that investigated MS risk following cigarette smoking. A total of 14 articles were included in this study. This represented data on 3,052 cases and 457,619 controls. We analysed these studies in both a conservative (limiting our analysis to only those where smoking behaviour was described prior to disease onset) and non-conservative manner. Our results show that smoking is associated with MS susceptibility (conservative: risk ratio (RR) 1.48, 95% confidence interval (CI) 1.35-1.63, p<10(-15); non-conservative: RR 1.52, 95% CI 1.39-1.66, p<10(-19)). We also analysed 4 studies reporting risk of secondary progression in MS and found that this fell just short of statistical significance with considerable heterogeneity (RR 1.88, 95% CI 0.98-3.61, p = 0.06).Discussion: Our results demonstrate that cigarette smoking is important in determining MS susceptibility but the effect on the progression of disease is less certain. Further work is needed to understand the mechanism behind this association and how smoking integrates with other established risk factors.

Type: Article
Title: Smoking and Multiple Sclerosis: An Updated Meta-Analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0016149
Publisher version: http://dx.doi.org/10.1371/journal.pone.0016149
Language: English
Additional information: © 2011 Handel et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This work was funded by the Wellcome Trust [GRANT NUMBER 075491/Z/04] and Medical Research Council [GRANT NUMBER G0801976]. SVR is a Goodger Scholar at the University of Oxford. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Keywords: LIFE-STYLE FACTORS, CIGARETTE-SMOKING, RHEUMATOID-ARTHRITIS, ORAL-CONTRACEPTIVES, RISK-FACTOR, PROGRESSION, EXPOSURE, DISEASE, MS, EPIDEMIOLOGY
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/1319866
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